Therapeutic Effect And Mechanism Of Tongyan Spray On Rats With Dysphagia After Stroke

Background:Stroke is an acute cerebrovascular disease that causes brain tissue damage or dysfunction caused by a sudden rupture of the brain's blood vessels or a blockage of blood vessels that leads to the inability of the bloodstream to flow into the brain.The data show that not only the incidence of stroke is high,but also the disability rate is high,which seriously affects the patient's health and quality of life.Stroke is one of the most common causes of dysphagia,with more than 50%of patients suffering from dysphagia after stroke.Dysphagia not only affects the patient to eat,cause malnutrition and other symptoms,but also increase the incidence of aspiration and pulmonary infection,prolong the patient's hospitalization time,increase the patient's mortality rate.The existing treatment of dysphagia after stroke is mainly rehabilitation training,or supplemented by traditional Chinese medicine and acupuncture treatment.However,the individualized rehabilitation training of the system is higher for the medical staff,often the cost is high and the patient is not easy to insist,the curative effect of acupuncture is good but the operation has a certain danger,the Chinese herbal medicine is due to the symptom of swallowing difficulty easily system cough etc.Clinical study of Tongyan spray(including Ginger,Clematis,etc.)oral and pharyngeal external,with simple operation,local drug use,no side effects,such as the advantages of early clinical studies show that it has a good effect on dysphagia after stroke,but its mechanism is not clear.Objective:To investigate the mechanism of Tongyan spray in the treatment of dysphagia after stroke,and to provide a theoretical basis for clinical application.Research methods:1.On the HEK293 cells transfected with TRPV1 receptors,the whole-cell patch clamp technique was used to detect the activating effect of the Tongyan spray on the TRPV1 receptor.The strength of the TRPV1 current was induced by the active ingredient 6-gingerol of ginger in the Tongyan spray.2.The male SD rats were randomly divided into normal group,sham Operation Group,model group and Drug group,the latter two groups used the Suture method to block the middle cerebral artery 90min to establish the stroke swallowing difficulty model,the drug group gave the Tongyan spray treatment for 14 days.The number of swallowing caused by distilled water and swallowing latency time of each group were recorded on the 7th day and 14th day.3.After 14 days of Tongyan spray treatment,Enzyme Linked Immunosorbent Assay(ELISA)detected the content of substance P(SP)and serum Calcitonin gene-related peptide(CGRP)in each group.The contents of SP and Serotonin(5-HT)in the nucleus of medullary solitary bundle were detected by immunohistochemistry.Results:1.Whole-cell patch clamp experiment1.1 Whole-cell patch clamp experiment with Tongyan spray established 1:1000,1:500,1:200 and 1:100 four dilution multiples.Compared with resting state,there was no statistically significant difference between 1:1000 TRPVl current and control group(P>0.05).1:500,1:200,1:100 diluted pharyngeal sprays can activate the TRPV1 receptor,causing current changes(P<0.05)?The TRPV1 current increased with the increase of concentration.1.2 The concentration of 6-gingerol 0.04mM,0.08mM,0.2mM and 0.4mM was established according to the content of ginger in the pharyngeal spray.Compared with resting state,0.04mM,0.08mM,0.2mM and 0.4mM concentration of 6-ginger phenol can induce TRPV1 current variation(P<0.05),the TRPV1 current peak value is increased with the increase of concentration,but there is no statistically significant difference between groups(P<0.05).TRPV1 current change ratio =(sample TRPV1 current peak-control current peak)/capsaicin induced TRPV1 current peak-control current peak),Based on this ratio,to compare the effect of 6-gingerol and Tongyan spray on the TRPV1 activation.The TRPV1 current caused by 6-gingerol is greater than the TRPV1 current caused by the Tongyan spray(P<0.01).2.Animal experimentThere was no statistically significant difference in the number of swallowing and swallowing latency time on the 7th day.It is showed that Tongyan spray can significantly increase the number of swallowing(P<0.05)on the 14th day.ELISA results indicated that Tongyan spray can dramatically improve the SP?CGRP content in the serum of tMCAO rats(P<0.05).While,the rise of positive fiber level of SP and 5-HT in the NTS was observed by immunohistochemistry(P<0.05,P<0.01).Conclusion:1.The Tongyan spray can activate the TRPV1 receptor,and the activating effect of the Tongyan spray on the TRPV1 receptor is increased with the increase of drug concentration at a certain concentration,But there was no statistically significant difference.;The TRPV1 current induced by the 6-gingerol was greater than that of the TRPV1 receptor induced by the compound of the Tongyan spray.2.The method of transient middle cerebral artery occlusion for 90min by wire can detect the decrease of swallowing caused by distilled water and prolonged swallowing latency time on the 14th day after operation,so it can be used as a dysphagia after stroke model.3.After 14 days of treatment with Tongyan spray,it can improve the swallowing function of transient middle cerebral artery occlusion(tMCAO)rats,and its mechanism may be related to activating TRPV1 receptor,increasing peripheral and central SP secretion,increasing the 5-HT-positive nerve fiber content in the Nucleus of solitary tract,making the nerve excitability enhanced,Causes the brain stem swallowing center to reach the threshold level of excitement to increase and then promote the swallowing reflex.At the same time,the activation of TRPV1 increased the secretion of Calcitonin gene-related peptide(CGRP)in the blood vessel,which was helpful to the cerebral vasodilation and the improvement of cerebral ischemia.